Introduction to Phlebotomy

• Phlebotomy is the process of collecting blood through the vein by using incision or puncture methods to draw blood for analysis or as part of therapeutic or diagnostic measures under the physician's request.
• Derived from two Greek words: phlebos which means vein and temnein which means to cut.
• Phlebotomy is also called venesection.
• Stone age - used crude tools to cut vessels and drain blood from the body.
• Ancient Egyptians - a form of "Bloodletting" (1400 B.C)
• Hippocrates (460 - 377 BC - balance of the four humors, removing excess by bloodletting.
• Middle ages - used to treat illness and performed by barber-surgeons
• 17th and 18th century - treated as major theraphy
• Cupping

  • alternative medicine
  • application of special heated suction cups on the patient's skin
  • incision using a fleam or lancet
• Leeching

  • known as Hirudotheraphy
  • used leeches for bloodletting
  • used for microsurgical replantation
• The main goals of the phlebotomy practice are:

  • For diagnosis and treatment using blood samples
  • for transfusion, to remove blood from the donor
  • for removal of blood for polycythemia or therapeutic purposes
• Two methods used in Phlebotomy

  1. Venipuncture: method of blood collection using a needle inserted in a vein
  2. Capillary Puncture: done by puncturing the skin
• Role of the Phlebotomists

  The main role is to collect blood samples for laboratory testing or for transfusion.

  They need to:

  1. Properly label the collected blood samples
  2. Deliver or transport the collected samples within the appropriate prescribed time limits
  3. In other institutions, they also process by centrifuging and aliquoting samples ready for laboratory testing.
  4. Assist in collecting other specimen such as urine.
  5. Blood-letting activities
• Traits that form the professional image of the phlebotomist

  Good phlebotomists possess the following skills and knowledge:

  1. Good manual dexterity
  2. special communication skills
  3. good organizational skills
  4. thorough knowledge of laboratory specimen requirement
  5. trained in phlebotomy skills coupled with standard practice
• Credentials

  Phlebotomists need to maintain certain credentials in the continuous practice of their profession. They should have:

  1. Certification
  2. License
  3. Continuing education
• Categories in healthcare setting

  1. Inpatient (non-ambulatory) - patients require to stay in the hospital for at least one night or two to be serviced by health care providers or tertiary care practitioners.
  2. Outpatient - patients are served by secondary care specialists on the same day
• The healthcare setting

  Primary level - refers to health units in the rural areas and sub-units which are operated by the DOH
• Secondary level - refers to non-departmentalized hospitals that attend to patients during the symptomatic stages of an ailment
• Tertiary level - refers to medical centers and large hospitals where services are sophisticated coupled with highly technical facilities that can address serious diseases.
• Ambulatory care - medical care given to outpatients or patients requiring care or follow-up check-ups after their discharge from the hospital
• Homebound service - refer to procedures, tests and services provided to a patient which are done in a patient's home or in a long-term facility.
• Public health services - belong to the unit at the local level but are still under the jurisdiction of the health department of the government. Services offered with little or no charge at all.
• STAT laboratory - this is usually located near the emergency room of some tertiary-care facilities so that procedures and tests can be done immediately when needed.
• Reference laboratory - is a large and independent laboratory that provides specialized and confirmatory laboratory tests for blood, urine and tissues and offer faster turnaround or processing time.
• Clinical Area

  Hematology - blood and blood forming tissues
• Clinical Area

  Coagulation - ability of blood to form and dissolve clots.
• Clinical Area

  Chemistry - performs most lab test for plasma, white blood, urine, etc.
• Clinical area

  Serology/Immunology - Serum and autoimmune reactions
• Clinical Area

  Urinalysis - tests urine specimens
• Clinical Area

  Microbiology - microorganisms in body fluids or tissues
• Clinical Area

  Blood Bank or Immunohematology - blood for transfusion
• Clinical Area

  Chemistry - amounts of certain chemicals in a blood sample
• Hematology

  Hematocrit (HCT) - hemoglobin level and red cell count
• HEMATOLOGY

  Hemoglobin (Hgb) - tests the value to rule out anemia
• HEMATOLOGY

  Red Blood Cell (RBC) count - erythropoietic activity
• HEMATOLOGY

  White Blood Cell (WBC) count - leukocyte response
• HEMATOLOGY

  Platelet Count (Plt ct) - chemotherapy and radiation occurs
• HEMATOLOGY

  Differential White Blood Cell Count (Diff) - monitors changes in the appearance or quantity of specific cell types
• HEMATOLOGY

  Indices - show the changes in RBC size, weight, and Hgb content
• HEMATOLOGY

  Mean Corpuscular Hemoglobin (MCH) - weight of the hemoglobin in the cell